Weather as a possible risk factor for massive ocular decompression retinopathy: A case report

Introduction Numerous studies described a link between weather phenomena and an increased incidence of cardiovascular and cerebrovascular events. We report a case of ocular decompression retinopathy with massive premacular haemorrhage secondary to acute intraocular pressure reduction in a patient with acute primary angle closure. At the time of admission, a change in weather conditions occurred with high temperatures and a strong Foehn wind known locally as halny. Case description A healthy 56-year-old man with acute primary angle closure who developed severe ocular decompression retinopathy with large prefoveal subhyaloid haemorrhage after pharmacological treatment was admitted to the hospital. The patient was elected for surgery and underwent vitrectomy with improvement of visual acuity to the baseline vision. Conclusions This report suggests that, in addition to an abrupt reduction in intraocular pressure as a causative factor, massive ocular decompression retinopathy may be significantly influenced also by environmental factors such as halny.

Bruch's membrane opening – minimum rim width measurement after acute primary angle-closure

Purpose To evaluate Bruch's membrane opening – minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer thickness (RNFLT) following an acute primary angle-closure attack (APAC). Materials and methods Nine consecutive patients with unilateral APAC were included. Patients with a bilateral attack, with signs of glaucomatous optic nerve damage or evidence of a previous APAC in either eye were excluded. Three months after the attack, all eyes underwent BMO-MRW and RNFLT measurements with SDOCT. APAC eyes were compared to the contralateral eyes. Results Three months after the attack, mean BMO-MRWs were 281.22 ± 56.88 μm and 313.78 ± 43.48 μm ( P = 0.009) and mean RNFLTs were 78 ± 15.36 μm vs 95.78 ± 10.81 μm ( P = 0.008) in the APAC and contralateral eyes, respectively. RNFLT and BMO-MRW measurements had a strong positive correlation ( R = 0.7436, P = 0.013). APAC eyes had a shorter axial length (21.85 ± 1.21 vs 22 ± 1.07, P = 0.042) and shallower anterior chamber depth (2.29 ± 0.21 vs 2.41 ± 0.12, P = 0.039) than contralateral eyes. IOP at presentation showed a strong negative correlation with both BMO-MRW ( R = −0.7669, P = 0.009) and RNFLT measurements ( R = −0.7723, P = 0.008). Conclusion BMO-MRW and RNFLT measurements are significantly reduced 3 months after an APAC when compared to the contralateral eye. IOP at presentation may have an impact on the reduction of these parameters.

A Study on Changes in Plasma Cholinesterase in Patients with Acute Primary Angle Closure

Purpose To analyze the differences in plasma cholinesterase (pChE) among patients with acute primary angle closure (APAC), patients with chronic primary angle closure glaucoma (CPACG) and normal people scheduled for cataract surgery and to analyze the relationship between intraocular pressure (IOP) and pChE in order to explore the significance of pChE in the pathogenesis of glaucoma. Methods Retrospective case series. Nighty-four patients with APAC, 72 patients with CPACG and 95 normal controls were enrolled in this study. All patients excluding those with diseases that may affect pChE underwent routine blood biochemical examination. Pearson correlation analysis was used to further analyze the correlation of IOP with pChE. Results There was no significant difference in age or sex among the three groups. The difference in IOP among the APAC (43.8 ± 12.2 mmHg), CPACG (25.6 ± 7.4 mmHg) and normal groups (13.6 ± 1.8 mmHg) was significant (P = 0.000). There was a significant difference in pChE between patients with APAC (7450.89 ± 1748.49 IU/L) and normal subjects (7994.68 ± 1321.90 IU/L) (P = 0.000) and between patients with APAC and those with CPACG (7969.44 ± 1572.14 IU/L) (P = 0.000). There was no significant difference in pChE between CPACG patients and normal subjects (P = 0.932). There was a moderate negative correlation between IOP and pChE in APAC patients (r = -0.410, P = 0.000), while there was no significant correlation in CPACG patients (P = 0.228) or normal subjects (P = 0.341). Conclusion APAC patients with higher IOP had lower pChE, which may have been related to IOP-induced neuroinflammation. It may provide a new strategy for optic nerve protection in glaucoma patients.

Low-dose transscleral cyclophotocoagulation with subsequent phacoemulsification in the treatment of prolonged acute primary angle closure

BackgroundTo explore the outcomes and mechanisms of intraocular pressure (IOP) control using low-dose transscleral cyclophotocoagulation (LDTSCP) followed by phacoemulsification in patients with prolonged acute primary angle closure (APAC).MethodsPatients with prolonged APAC refractory to all other treatment modalities were prospectively recruited, and underwent LDTSCP (10 shots, 2 s duration, 120° treatment with the energy starting at 1500 mW and titrated to the level with audible burst but not exceeding 2000 mW) and anterior chamber paracentesis 1 week prior to phacoemulsification with intraocular lens implantation and viscogoniosynechiolysis. Postoperative IOP, vision, anatomic changes on anterior segment optical coherence tomography and complications were recorded.ResultsTwenty eyes with prolonged APAC were recruited. Median follow-up was 12 months (range 9–18), at which point the vision in all eyes had improved and IOP was ≤17 mm Hg on no antiglaucoma medications. Following LDTSCP at postoperative day (POD) 1, IOP decreased in all eyes to a median 15 mm Hg (range: 6–28 mm Hg). Post-LDTSCP supraciliary effusion (SCE) occurred in 90% of eyes on POD1 or POD7 and ciliary body defect (CBD) was detected in 30% of eyes and resolved in all cases by postoperative month 1. Lower post-LDTSCP IOP was associated with more number of bursts (r=−0.558, p=0.011) and higher grade of SCE (r=−0.877, p<0.001), but not with total energy (p=0.240). Eyes with CBD (p=0.018) and a higher number of bursts (r=0.657, p=0.002) had higher grade SCE.ConclusionsLDTSCP-induced SCE may explain the post-LDTSCP IOP reduction seen in eyes with prolonged APAC. LDTSCP instead of traditional more extensive treatment, was sufficient to provide a relatively safe and effective bridge therapy prior to phacoemulsification.Trial registration numberChinese Clinical Trials Registry (ChiCTR1900023567).

Potential effects of angiogenesis-related factors on the severity of APAC and surgical outcomes of trabeculectomy

Background EPO (erythropoietin) and PDGF (platelet derived growth factor) families are thought to be associated with angiogenesis under hypoxic condition. The sharp rise of intraocular pressure in acute primary angle closure (APAC) results in an inefficient supply of oxygen and nutrients. We aimed to measure the expression of EPO and PDGF family members in APAC eyes and demonstrate their associations with APAC’s surgical success rate. Methods Concentrations of EPO, PDGF-AA, -BB, -CC and -DD collected in aqueous humor samples of 55 patients recruited were measured. Before operations, correlations between target proteins and IOP (intraocular pressure) were detected between APAC (acute primary angle closure) and cataract patients. Based on the post-operative follow-up, the effects of EPO and PDGF family members on the successful rate of trabeculectomy were tested. Results The levels of EPO, PDGF-CC and -DD were significantly elevated in the APAC group compared to the cataract group. During the post-operative follow-up, EPO, PDGF-CC and -DD showed significant differences between the success and failure groups. In multivariable linear regression analyses, failed filtration surgery was more likely in APAC eyes with higher EPO level. The Kaplan-Meier survival plot suggested that the success rate in eyes with low EPO level was significantly higher than that in eyes with high EPO level. Conclusion The levels of EPO, PDGF-CC and -DD were significantly elevated in failure group. EPO level correlated with preoperative IOP and numbers of eyedrops, and higher EPO level in aqueous humor is a risk factor for trabeculectomy failure. It can be a biomarker to estimate the severity of APAC and the success rate of surgery. The investigation of mechanism of EPO in APAC a may have potential clinical applications for the surgical treatment of APAC.